Background: Each year, 7 million children are hospitalized in the US, putting them at risk for medical errors. 2 Children suffer three times as many medical errors as adult patients. Because children are not fully capable 3 of employing the communication techniques recommended to adult patients to reduce errors, engagement of 4 their families in their healthcare is essential. To facilitate family engagement, recommended practice is to 5 conduct bedside rounds in patients' rooms with the family present. Recently, more institutions are 6 conducting rounds at the child's bedside, attempting to engage families. However, to our knowledge, no 7 institutions have objectively assessed whether these rounds are successful in improving safety or engaging 8 families. Objective: The overarching goal of this study is to leverage family engagement in bedside rounds 9 to improve the safety of care provided to hospitalized children. Building on the PI's K08 patient safety award, 10 this project will 1) evaluate how family engagement achieved during bedside rounds influences safety for 11 hospitalized children, 2) use systems engineering approaches to implement an intervention to foster 12 engagement of families, 3) compare the effectiveness of pre- and post-intervention bedside rounds with 13 regard to safety and family engagement, and 4) assess how family engagement mediates any effect of the 14 intervention on safety. Research Plan: Videos of bedside rounds and survey data will be collected on the 15 day after admission and at discharge for 150 families before (75 from the intervention hospital unit and 75 on 16 a control unit) and 150 families after (75 from each of unit) the intervention, resulting in a sample of 600 17 bedside rounds videos and survey data. Safety indicators relevant to common pediatric hospitalizations 18 include safe practices (hand hygiene and medication awareness) and parent perceptions of safety, assessed 19 from clinical data or family surveys. Family engagement in specific bedside rounds communication tasks 20 (relationship building, information exchange, and deliberation), will be objectively assessed from the videos, 21 using the PI's validated measures. Accepted systems engineering methods (stimulated recall and proactive 22 risk assessment) will be used to generate and prioritize strategies addressing known barriers and facilitators 23 of family engagement in our bedside rounds. We will relate safety to family engagement, compare safety 24 and family engagement pre- and post-intervention, and assess whether any relationship between the 25 interventions and safety occurs through family engagement. Analyses will include qualitative techniques, 26 descriptive statistics, and path analyses that adjust for covariates and clustering of observations. 27 Significance: This work will inform implementation of interventions to improve family engagement and will 28 addresses whether and how family engagement can improve patient safety. In addition, findings will inform the 29 education of healthcare providers, guide policies for care provision during pediatric hospitalizations, and 30 support future evaluations of interventions to improve family engagement and pediatric patient safety. Each year, 7 million US children are hospitalized, placing them at risk for disproportionately high rates of medical error. In part, this is because children cannot avail themselves of error-reducing communication techniques. Thus, family engagement in children's healthcare encounters has been suggested as a means to improve safety. To engage families in care, recommended practice is to conduct rounds at the child's bedside with the family present. By investigating the relationship between family engagement during bedside rounds and hospital safety, while also intervening to foster family engagement, this work aims to inform interventions and policies that improve pediatric patient safety and support family engagement in children's healthcare.